Tag Archives: clients

Visiting the very pet-friendly town of Carmel, California is a treat for dog lovers like me. Many of the restaurants have items on the menu just for your dog. Most of the inns allow pets. Dogs are welcome to romp on the beach. Boutiques sell trendy pet supplies. And you can play “Name That Breed” as you stroll the sidewalks downtown people-pet watching.

When I lived near Carmel, I used to like to play with people by walking one of my dogs along the Carmel streets. “Lucy” was small, perky, white, and full of spunk on her leash. To me, she looked like a cross between a Jack Russell Terrier and a Chihuahua. Her paperwork from the Monterey County Animal Shelter from where I adopted her merely said she was impounded as a stray from the town of Greenfield in a more inland part of Monterey County. Whenever asked by curious Carmel pet admirers, “What breed is your dog?” I typically responded, “She is a Greenfield Terrier,” and just kept walking. That answer was probably a bit mean. I imagined those curious people rushing home to their breed identification books searching for more details about “Greenfield Terriers.” Since there are so many different types of Terriers, the “Greenfield Terrier” certainly sounded plausible. However, “Lucy” was just a “Custom Bred” mutt, not a purebred dog.

If I could have cloned “Lucy” the Greenfield Terrier” I bet I could have sold her clones very easily–even if she wasn’t a breed actually recognized by the American Kennel Club. Currently, designer-breeds of dogs are very popular. Each week, I examine new puppies that clients have purchased with breed names such as: Morkie (a cross between a Maltese and a Yorki), or Schnoodle ( a Schnauzer crossed with a Poodle), or Bug ( a Boston Terrier crossed with a Pug), or a Cavashon ( a Cavalier King Charles crossed with a Bichon Frise). The list of possibilities is endless. All of these puppies are adorable. But surely people who pay hefty purchase prices for these custom-bred dogs recognize they are paying for mutts, don’t they?

A purebred dog will be able to reproduce with another dog of the same breed and produce offspring that look like the parents or the grandparents. While not clones, the puppies should all breed true to conformation. Thus two Beagles will produce puppies that look like more Beagles. But two Bugs that mate will produce puppies that look only like second-generation mutts. If you cross a Bug mutt with a Bug mutt, the next generation will not necessarily resemble the earlier generation of Boston or Pug. Designer dogs are not true breeds of dogs, no matter what the selling price. They are just “Custom Bred” for looks and profit.

Irresponsible breeding of dogs for looks and profit can result in heartache for purchasers and suffering for the dogs. Over the past few months I have examined multiple designer puppies with serious health issues. Some of the puppies had treatable problems, such as intestinal infections or tooth problems . But others had serious orthopedic issues, for which the new pet owners were not financially prepared. One puppy had a birth defect in its shoulder joint that resulted in a lame front leg that needed expensive orthopedic surgery. Another puppy became paralyzed at five months of age because its cervical spine was malformed. I was able to temporarily stabilize its neck by fashioning a brace out of a paper cup. But a consultation with a neurologist gave no hope of any long-term recovery, and so the puppy was euthanized. The pet-owner was devastated.

Bottom line: if you want a healthy puppy, adopt from a shelter or buy from a responsible breeder of purebred dogs. Good shelters and good breeders will give you some limited health guarantees and want you to see their facilities. Responsible breeders and shelters do want to make a profit, but they are also interested in maintaining good reputations for quality animals. Irresponsible breeders focus on your money and don’t stand behind the health of the puppies. Such breeders probably won’t let you see their breeding facility or meet the parents. Such lack of transparency should make you question whether the seller is running a puppy-mill that doesn’t humanely care for the dogs.

Recently a reader of this blog asked me to discuss FIP (Feline Infectious Peritonitis). I am happy to oblige and appreciate the suggestion. If you have topics you would like to learn more about, please let me know in your comments.

(FIP) is a deadly virus that affects mostly young cats and kittens. The FIP virus doesn’t act much like any other virus common to pets. Affected cats don’t survive the infection, although they can linger with symptoms for some time. Unfortunately, there currently are no vaccines that protect against this virus, and there is no exact way to diagnose the infection while the cat is still alive. FIP remains a diagnosis of suspicion until confirmed after death with a necropsy. The cat must be the right age, coming from the right background, and with the right symptoms to be considered possibly infected. It is definitely a frustrating disease for veterinarians to diagnose and for pet owner’s to experience.

FIP is a form of the very common Feline Corona Virus. Almost every kitten is exposed to Corona Virus soon after birth. Corona Virus lives in the GI (gastrointestinal tract) of cats, usually without symptoms and is spread by cat feces. A few cats will have symptoms of mild diarrhea or sneezing, but most cats show no symptoms of Corona Virus at all. Because it is such a common virus, testing a cat for antibodies to corona virus does not verify a diagnosis FIP. Having a blood titer that is positive for Corona Virus simply means that a cat was previously exposed to Corona Virus. A higher titer doesn’t mean a cat
has FIP. It just means the cat might have an active or recent infection of Corona Virus.

For a few cats, the normally mild form of Corona Virus seems to mutate to the deadlier FIP. For these unlucky cats, their own immune system carries the disease throughout their bodies. The virus then affects internal organs in one of two ways. In the “wet” form of the disease, the cat’s chest and/or abdomen begins to slowly fill with a sticky, yellow, fluid. By the time this becomes noticeable, the cat already has difficulty breathing, eating, or moving. Veterinarians can temporarily drain the fluid from body cavities, and testing the fluid can help support a diagnosis of FIP. In the “dry” form of the disease, there are no outward symptoms. The cat slowly deteriorates, and blood work shows multiple organ failures. Biopsies can support the diagnosis. Sadly, FIP is almost always fatal.

Feline Corona Virus seems more likely to mutate to FIP in cats exposed to large numbers of other cats. FIP is more common to cats that once lived in a colony, rescue, shelter, or other facility where many cats mingled. And, research also seems to point to a common genetic link among the affected cats. Only those cats with a genetic susceptibility to the virus that are also exposed to the form of the virus that is more likely to mutate, develop FIP. It happens to a few unlucky cats every year.

For now, there is no way to predict which cats will be affected. The best a pet owner can do to prevent the disease is keep your cat well fed, well vaccinated, and away from other cats. If you must bring a new cat into the home, keep the new cat isolated from your other cats until your veterinarian gives you the OK to let them mingle. FIP isn’t the only disease that cats freely share. So a short quarantine time can prevent many problems when introducing a new cat to the household.

Veterinary scientists are busy working on better diagnostics, treatments, and preventions. Fortunately, FIP is still a rather rare infection. But those unlucky few cat owners who experience the disease are forever scarred.

So who is afraid of FIP? I am. I hate to diagnose it, and I hate that I can’t prevent it.

(Fair Warning: This blog post includes MATH! If you are math phobic, please relax. There is no test at the end!)

My son is learning to cook. After one memorable mistake, he learned the difference between a teaspoon (t) and a tablespoon (T) of salt. That tiny difference in
measurement was very noticeable in the recipe. Thus, he learned that accuracy can avert disasters. I hope he applies that lesson to many other aspects of life.

Accuracy is vitally important for preventing medication errors. You certainly wouldn’t want your veterinarian to make any errors in dosing your pet’s prescriptions. Because it is so easy to transpose a number or misread a prescription, medical professionals have multiple safeguards in place to help prevent dosing errors. Quality control systems include requiring two staff members to approve a prescription, counting pills twice, and completing annual continuing education courses in pharmacy rules and regulations. Safeguards also include training staff to answer the 4R’s before giving medications; 1. Is this the right drug to give? 2. Is this the right patient? 3. Is it the right amount to administer? 4. Is this the right route? Math is very important for dosing medications accurately. Calculating a correct dose of medication requires basic algebra. Multiple times each day I convert pounds (lbs) to kilograms (kg), and then calculate the number of milligrams (mg) or millilitres (ml) required to give an animal based on the strength of the drugs I have available to use.

For example, to give a 15 mg/kg dose of antibiotic to a 50 lbs dog, I use the following formula:

I don’t guess. I do the math each time. No shortcuts allowed. And I usually triple check my calculations because I worry about making an error. After
all, a misplaced decimal point could mean the difference between drawing up 3.4 ml and 0.34 mls in a syringe. Only one dose is correct. The other dose could result in harm. The veterinary oath implores me to “First do no harm.” I take that seriously.

If I go through these gyrations each time I give a dose of medication to your pet, why would a pet owner be willing to take short cuts? It seems like a risky choice.

This week, I learned of just such a risky choice that resulted in a trip to the veterinary emergency room for two pets. It was a penny wise, but prescription foolish choice. The pet owner opted for “do-it-yourself” veterinary medicine to save some bucks. I don’t blame them for trying. Prescriptions are expensive.

This pet owner noticed that the active ingredient in popular prescription heartworm prevention for dogs was also sold over-the-counter in feed stores for use with livestock. The difference was that the dog medication is dosed in micrograms (mcg) and the livestock medication is dosed in milligrams (mg). The difference is a thousand fold. It is the same difference between a thousand dollars or a million dollars—just three little zeros. While the active ingredients in the two medications are the same, the strengths are completely different. The pet owner gave what looked to be a very tiny amount of the cheaper livestock drug to each dog. A few hours later, both dogs began to seizure and nearly died.

This was a disaster that could have been averted by simply checking with a veterinarian first. Perhaps the pet owner should go to my son’s cooking class.
A micro-ounce of prevention is better than mega-bucks spent in the emergency room because of a dosing error.

I’m happy to report that both dogs survived due to the skill of the emergency veterinarian who earned every penny that night. Let livestock take their medicine. And let small animals take their own medicine. Remember, accuracy can avert disasters.

Admit it. You have a couple of cats as pets. Maybe the cats live in the house full-time. Maybe the cats are indoor-outdoor models. Or maybe, you don’t really claim the cats; you just feed the cats every day outside your back door. Cats are like potato chips; you usually can’t have just one.

Having more than one cat to call your own is apparently the norm in America these days. In fact, according to many surveys of American pet ownership, more than 50% of the American public has a pet and most of those pets are cats. Who knew that the cat had replaced itself as a human’s best friend?

But if most of the pet-owning public owns at least one cat, where are they? More dogs than cats regularly visit veterinary offices. It seems that clients willingly bring their dogs for exams and veterinary care, yet leave the cats at home. If there are so many cats in the U.S, why don’t cats visit the veterinarian as often as do dogs?

Perhaps it is the dreaded chore of getting the cat into a carrier to travel to the veterinarian’s office? It is definitely a risky task to stuff an unwilling cat into a travel box. Cats have their ways of showing who the boss in the relationship is! The trick is to make the cat think he/she thought of the idea first. Here are some tips to convincing your cat that the carrier really is a safe place:

Regularly leave the carrier out for cats to explore. Cats like to play in most boxes and bags, why not the carrier?

Use the carrier as the daily feeding or treat dispensing station.

Store favorite cat toys in the carrier and encourage the cats to play in the carrier.

Spray the inside of the carrier with Feliway spray (an over-the-counter pheromone spray that calms cats).

Travel with your cats on short trips to places other than the dreaded vet’s office. Otherwise, cats quickly associate the carrier with trouble.

Or perhaps cats don’t visit the veterinarian as often because disease symptoms of cats are more subtle than in dogs. A dog will usually grab your attention and almost shout, “I am sick here!” Cat’s, on the other hand, gradually fade away. They are typically finicky eaters to begin with, can stay hidden for several days even if they feel well, sleep most of the day anyway, and hide their bathroom habits in a box that isn’t always cleaned daily. So a cat with decreased appetite, lack of energy, increased urination, or diarrhea might go unnoticed for several days.

Because cats are such masters at hiding their symptoms, it is very important to keep up with veterinary visits. A veterinary exam can detect feline diseases early, when those diseases are less expensive to treat. Your veterinarian will likely recommend blood tests because many feline diseases can only be detected that way. Blood tests can detect common cat diseases such as kidney disease, urinary track problems, thyroid disease, diabetes, heartworm infection, and feline immunodeficiency virus (FIV).

The one thing that cats don’t need every year is vaccines. Cats do need protection from viral diseases, just not every year. Over vaccination of cats can result in life-threatening tumors, referred to as “Vaccine Associated Sarcomas.” Let your veterinarian be your guide for setting an appropriate vaccine schedule for the risks faced by your cats.

Cats do need other cost-effective preventions. Cats need microchips, flea control, regular deworming, heartworm prevention, dental care, and blood tests to keep them healthy. But of course, to get these preventions, your cat first has to go to the vet.

This week I examined a cat that hadn’t been to the vet in at least six years. The cat’s owner really loved this cat. The cat had been the companion to an ill husband for the past few years until the husband died. To the owner, the cat seemed like it was “getting old.” It was skinny, weak, and drinking a lot of water. In fact, the cat that used to weigh 10 pounds, now weighed only 4 pounds. Its heart was racing at over 200 beats-per-minute instead of the more normal 120 beats-per-minute. It’s gums were pale instead of pink, and it was dehydrated despite having a great thirst. The cat was old, but it was also in kidney failure and suffering from an over-active thyroid gland. It was hard to tell this client that age is not a disease. I wish I could have diagnosed this cat’s problems years earlier. But first, the cat would have needed to go to the vet.

I frequently visit classrooms to talk about careers in veterinary medicine. When I ask how many students desire to be future veterinarians, most of their hands wave high. When I ask how many of them have pets at home, almost every hand is raised. And when I ask them why they want to become a veterinarian, they uniformly exclaim, “Because we love animals.” That is the teachable moment.

The career of veterinary medicine attracts people who love animals. Of course, that should be a prerequisite to study. It would be a tragic career move for someone who greatly minded being regularly covered with fur, feathers, and feces. After some work days, I look as if I just taped an episode of Dirty Jobs. But there is certainly more to this career than just liking animals.

Admission to a college of veterinary medicine is highly competitive. There are less than 30 programs in all of the U.S. Those accepted to professional veterinary training are great students, who got excellent grades in undergraduate science and math courses, and are driven to succeed. Almost every veterinary student holds a bachelors or masters degree in some area of science prior to admission. Because receiving an acceptance letter to veterinary school is like finding the pot-of-gold at the end of the rainbow, most pre-vet students postpone families, turn down higher paying jobs, and accept huge educational debt just to pursue a life-long dream of earning a DVM (or VMD) degree.

Once one begins practicing veterinary medicine, however, there is an instant and sometimes rude awakening. At the other end of every leash is a human.

I think of myself and my fellow veterinarians as highly competitive science geeks who must work well with others. Some of the others have four legs and some of them have two legs. You have to love people as much as you love animals to be successful as a veterinarian.

There are four sets of skills one must have to successfully practice as a veterinarian. Excellent animal handling skills are important when dealing with ill, biting, snarling animals that don’t feel like having an X-ray taken today. Excellent technical skills are important for making accurate diagnoses, performing surgery, and safely prescribing medications. Excellent business management skills are important because veterinary practices are primarily small businesses that have expenses, employees, budgets, marketing, and other administrative duties to attend to or the doors of the practice will close. Excellent communication skills are equally important so the veterinarian can explain disease processes, give estimates for services, counsel grieving owners, and advise owners about a course of action that fits within the family budget. One must be proficient in all four sets of skills to make it as a veterinarian. You can’t just love animals and be a successful veterinarian.

This week my son had surgery. I think how different was his experience from what happens when I perform surgery on someone’s furry family member. He was sent to a specific facility chosen by my insurance company, not necessarily convenient for us. My son met some of the surgical facility staff, but never met the doctor who actually performed his surgery. I only spoke with the surgeon once when my son was in recovery. My questions were answered by a staff member, not the doctor. No one provided an estimate of the costs of the procedure; they just expected me to sign a form that I would pay should the insurance company refuse to pay. Would a pet owner accept this treatment from me? I doubt it.

Pet owners have expectations at the other end of the leash. They expect to have a personal relationship with the veterinarian caring for their pets. Pet owners expect the veterinarian to personally examine their pets, personally perform the necessary procedures, call them after procedures, be available to take their phone calls with concerns or questions, and to be friendly and compassionate at all times. Pet-owners also expect the veterinarian to run a business that provides quality care efficiently, conveniently, yet inexpensively. It is a tough audience.

When I live up to those expectations, I frequently hear comments such as, “I get more information from you than I do my own doctor.” When I don’t live up to those expectations, pet owners vote with their feet and transfer their records elsewhere for care. Veterinary medicine is a very client-centered profession. Those who want to enter the profession need to be aware of who holds the leash.